Conservative Surgical Treatment of Pulmonary Hydatid Disease in Children: An Analysis of 35 Cases

Purpose. Hydatid cyst disease is a major health problem for people who live in endemic countries such as Turkey. The definitive cure for pulmonary hydatidosis is still surgical. This study evaluates our experience of treating pulmonary hydatidosis, focusing on the conservative surgical management of children with this disease. Methods. We retrospectively analyzed 35 children ranging in age from 3 to 13 years old, treated for pulmonary hydatidosis during a recent 4-year period. Results. The 35 patients had a collective total of 48 cysts. Twenty-seven patients had a single cyst, 7 had unilateral multiple cysts, and 1 had bilateral multiple cysts. Six patients had multiple coexisting liver cysts. The 33 pulmonary cysts were intact and uncomplicated. Of the total 48 cysts, 34 were larger than 5 cm in diameter. Fever, cough, and dyspnea were the most common symptoms and chest radiography gave a correct diagnosis in 96.4% of the patients. Conservative surgical treatment was carried out in 33 of the 35 children (94%). There were few postoperative complications, and no mortality or recurrence in this series. Conclusions. Parenchyma-saving surgical procedures such as cystotomy and capitonnage are the preferred methods of treatment for pulmonary hydatid disease in childhood. These simple procedures are safe, reliable, and successful. Combined medical treatment can be given but not as an alternative to surgery. Simultaneous surgical procedures for coexisting liver cysts may be preferred because of the lower morbidity rates and hospitalization. Ultrasound or computed tomography scanning should be done to detect coexisting liver cysts in every patient with pulmonary hydatid disease. Received: September 10, 2001 / Accepted: March 5, 2002     

Long-term Results of Surgical Treatment of Hydatid Disease

Background-Aims: non-radical surgery is the preferred method of treatment of hydatid liver disease, and is associated with low mortality and recurrence rate. The purpose of the study is the retrospective analysis of the outcome of patients who were treated surgically in a single institution.

Material and methods: between 1987 and 2005, 59 patients, mean age 58.2 ± 15.9 (13–83) years, underwent surgery for liver hydatid disease. The patients were reassessed with physical examination, serological tests and radiological examination for the evaluation of the recurrence rate.

Results: most cysts were solitary, the more frequently affecting the right lobe of the liver. Radical surgery was possible in four cases (6.8%) that were classified as PNM stage I. Partial cystectomy and omentoplasty was performed in 37 patients (62.7%) and external drainage with partial cystectomy in 18 patients (30.5%). The hospital morbidity was 27.2% and was found to be related to ASA class (p = 0.019). Hospital mortality was 5.1%. The median follow-up time was 94 (1–228) months and 45 out of 59 patients (76.3%) were reassessed, but no recurrence was recorded. There was no significant difference in morbidity, mortality, and hospital stay between partial cystectomy combined with external drainage or omentoplasty (p > 0.05).

Conclusions: PNM staging seems to be a reliable tool in selecting patients with liver hydatid disease for non-radical or radical surgery. Omentoplasty is an easy and effective surgical method for the treatment of hepatic echinococcosis but is not different than partial cystectomy and external drainage in regard to morbidity, mortality, and recurrence.     

219例肝内胆管结石的外科治疗

目的:总结并评价肝内胆管结石的外科手术治疗效果。方法:单纯胆道探查T管引流72例,肝叶(段)切除和胆肠内引流109例,胆总管切开并胆道镜钬激光碎石术取石 T管引流38例。结果:总治疗优良率83.8%,并发症率15.1%,死亡率0.5%,结石残石率14.1%。胆总管切开合并胆道镜碎石术应用者明显优于其他组。结论:充分利用先进的诊疗技术,选择合理的术式,保留Oddi括约肌功能,可有效提高治疗效果,降低并发症及残石率。     

Spontaneous Intraperitoneal Rupture of a Hepatic Hydatid Cyst

Hydatid cysts, which are endemic to certain areas, typically are found in the liver. Spontaneous intraperitoneal rupture, which can be life threatening, is rare. This article presents a case of spontaneous rupture of a hydatid cyst in a 69-year-old woman who was admitted to the emergency department. The patient had no history of trauma. Abdominal ultrasonography and computed tomography suggested rupture of a hydatid cyst. The patient underwent a partial cystectomy, and the cystic area was washed with hypertonic saline and the peritoneal cavity was washed with isotonic saline and drained. Postoperatively, the patient was treated with albendazole for 3 months. No additional pathology was observed at the 3-, 6-, and 9-month follow-ups. Although rare, a ruptured hydatid cyst should be considered in the differential diagnosis of the acute abdomen in a patient residing in an endemic area.     

腰椎间盘突出症手术治疗226例分析

目的 探讨腰椎间盘突出症的病因、临床特点和手术治疗。方法 自1990年～2004年收治腰椎间盘突出症的病人226例,采用手术治疗。结果 术后随访160例,平均随访5.1年,优120例,良30例,可7例,差3例,优良率为93.7%。结论 腰椎间盘突出症是一种常见病、多发病,影响正常的生活和劳动,只要严格掌握手术的适应症,才能确保疗效。     

143例胃肠道间质瘤的外科诊治及预后分析

目的:探讨胃肠道间质瘤的临床病理特征及外科诊治情况,分析影响预后相关因素。方法:回顾性分析经手术治疗的143例患者的临床资料。结果:发生于胃42.7%,小肠35.0%,腹痛不适44.1%,消化道出血或贫血28.0%。131例手术完整切除,免疫组化表型CD117阳性率为98.5%。中位生存时间为64.0个月,1、3、5年生存率分别为89.7%,72.4%和53.4%。手术切除的完整性和危险程度分级是影响预后的独立因素(P0.05)。结论:胃肠道间质瘤术前确诊率较低,手术完整切除是主要治疗手段,伊马替尼治疗晚期患者有一定疗效。影响患者预后的独立因素是肿瘤危险程度分级、手术切除的完整性和伊马替尼治疗。     

42例腹膜后纤维化致肾积水患者外科治疗效果分析

目的：对腹膜后纤维化肾积水患者外科处理后分析评价治疗效果。方法：回顾性分析2008年3月-2012年12月收治的42例腹膜后纤维化肾积水患者,并根据患者的病情不同分别采用单纯输尿管置管术14例,开放性输尿管腹腔内松解术26例,肾造瘘术2例。观察术后肾积水缓解、肾功能恢复情况并随访。结果：42例腹膜后纤维化肾积水患者中,35例接受外科治疗的患者其临床症状减轻或完全消失,肾功能得到了有效的改善;7例输尿管松解术后患者肾功能未能得到缓解,可能与术中输尿管松解不彻底或长期肾后性梗阻致不可逆性肾性肾功能不全有关。结论：腹膜后纤维化引起肾积水、肾功能不全的治疗原则是尽早解除输尿管梗阻,防止肾积水加重和肾功能的进一步恶化,外科处理效果明显。     

胸腰段椎体骨折的手术治疗

目的探讨胸腰段椎体骨折的手术治疗方法及其临床疗效。方法回顾性分析2003年1月至2010年12月我院76例新鲜胸腰段椎体骨折手术治疗病例。其中T113例,T1219例,L;40例,L214例。根据AO胸腰椎骨折分类,A型骨折34例,B型骨折7例,c型骨折35例。术前脊髓损伤（americanspinalinjuryassociation,ASIA）分级,A级14例,B级14例,C级38例,D级5例,E级5例。胸腰椎损伤分类及损伤程度评分系统（thoracolumbarinjuryclassificationandseverityscore,TLICS）评分均大于4分。采用后路减压固定后外侧植骨融合术66例,前路减压固定椎体间植骨融合10例,其中多节段固定31例,单节段固定45例。根据Oswestry功能障碍指数（oswestrydisabilityindex,ODD评分标准和脊髓损伤ASIA分级结合椎体压缩率、Cobb角和椎管狭窄率变化进行术前和术后的疗效评价,并对术前和术后椎体压缩率、Cobb角和椎管狭窄率进行统计学分析。结果76例患者获得12～48个月随访,平均32个月。ODI术后平均手术改善率为62．5％,优良率为69．8％;术后脊髓损伤ASIA分级均有不同程度的改善;术后所有患者的椎体压缩率、Cobb角和椎管狭窄率均有明显改善,与术前相比差异均有统计学意义（P〈0．05）。结论根据胸腰段椎体骨折患者病情和影像学检查结果,确定椎体骨折节段、损伤程度、AO分类及脊髓损伤严重程度等,选择适合的手术方法：术中椎管彻底减压,恢复和重建椎体高度,坚强稳定的内固定和植骨融合,可避免术后椎体高度丢失、内固定松动及断裂等并发症,获得较好的手术疗效。     

跖跗关节损伤的手术治疗

目的探讨跖跗关节损伤的手术治疗及其疗效。方法对46例跖跗关节损伤患分别用闭合复位石膏外固定(2例)、闭合复位克氏针内固定加石膏外固定(18例)、开放复位螺丝钉内固定加石膏外固定(26例)进行治疗，对其临床疗效进行评价。结果术后平均随访2．5a，手术治疗优良率达86．3％。8例发生创伤性关节炎，均为未达解剖复位，其中单纯石膏固定2例，克氏针固定3例，螺丝钉固定3例，7例单纯脱位中5例发生创伤性关节炎。结论手术治疗效果与骨折脱位的复位情况相关．创伤本身也是影响疗效的重要因素。     

Surgical Treatment of Elongated Styloid Process: Experience of 61 Cases

Aim: To describe the management of patients with elongated styloid process syndrome (Eagle's syndrome). Materials and Methods: Sixty-one patients with elongated styloid process were treated between 2000 and 2005. Computed tomography examination defines those whose symptoms suggest the diagnosis. Patients with styloid processes longer than 25 mm were treated by surgical resection. Results: Fifty-seven (93.4%) of 61 patients treated for Eagle's syndrome became asymptomatic after resection. There were no serious complications. Conclusion: Patients with clinically and radiologically established elongated styloid process can be managed successfully by surgical resection using an external approach.     

食管癌和贲门癌外科治疗进展—9107例资料分析

从１９６５年４月至１９９０年１２月我们对９１０７例食管癌和贲门癌病人进行外科治疗，其中食管癌６４２８例，贲门癌２６７９例。现重点比分析２５年间前１４年（１９６５－１９７９，Ａ组）和后１１年（１９７９－１９９０年，Ｂ组）的资料，以评价外科治疗的。总切除率为９０．１％，食管癌和贲门癌分别为９３．２％和８２．７％。总的５年生存率为３１．６％，食管癌和贲门癌分别为４０．３％和２０．９％。Ⅲ，Ⅳ期病例，Ａ，     

The Management of Residual and Recurrent Intracranial Aneurysms after Previous Endovascular or Surgical Treatment – A Report of Eighteen Cases

Summary  Object. We wish to report our experience in the management of residual or recurrent intracranial aneurysm after previous endovascular or surgical treatment.  Methods. We performed a retrospective review of the clinical notes, operation records and cerebral angiograms of eighteen patients who were known to have undergone treatment for residual or recurrent aneurysms.  Results. During the period of April 1994 to May 1999, 210 patients were treated for an intracranial aneurysm either surgically or by endovascular methods. Eighteen of these patients (8.6%) were subsequently treated for residual or recurrent aneurysm. Thirteen achieved a complete occlusion. Complete occlusion was achieved in five of the eight patients who underwent endovascular treatment as a second procedure. Seven out of ten surgical cases achieved complete occlusion. Fifteen patients made a good recovery according to the Glasgow Outcome Score. Two patients who presented in a poor grade subarachnoid haemorrhage (SAH) were left severely disabled. One patient died after retreatment.  Conclusions. The treatment of cerebral aneurysm remnants can be performed effectively using a variety of modalities. The original purpose of the treatment, which is total occlusion of the lesion, can thus be achieved.     

Surgical Treatment of Isolated Patellofemoral Osteoarthritis

Background

Isolated patellofemoral (PF) osteoarthritis (OA) affects 9% of persons older than 40 years. Nonoperative treatment should be exhausted fully before surgical treatment.

Questions/Purposes

The purpose of this article is to review the literature after 2008 with the aim of answering the following question: Which of the following surgical procedures has the highest survival rate and the lowest revision rate in advanced isolated PF OA: patellofemoral arthroplasty (PFA), total knee arthroplasty (TKA) or lateral facetectomy.

Methods

The search engine was MedLine. The keywords used were: PF OA and PFA. Three hundred and fifty-three articles were found between 2008 and 25 July 2013. Of those, only 23 were selected and reviewed because they were strictly focused on the topic and the question of this article.

Results

The types of studies reported so far have a low level of evidence (levels III and IV). Most of them are prospective case series (level IV). Some are systematic reviews of level III studies. Reported survival rate of lateral facetectomy is 85% at 5 years, 67% at 10 years and 47% at 20 years. Reported failure rate of lateral facetectomy is 26% at 10 years and 16% at 12 years. The reported average time of reoperation is 8 years and 37% of such procedures fail. Survival rate of PFA has been reported to be 87.5% on average (range, 60–100%). The revision rate of PFA is 20%. Recent improvements in PFA design have resulted in improvements in short-and medium-term results, similar to those of TKA.

Conclusions

There is still no gold standard for the surgical treatment of isolated PF OA. However, PFA or TKA appear to be the most recommendable treatment in cases that do not respond to conservative treatment.     

Surgical Treatment of Dislocations of the Sternoclavicular Joint

Six patients with dislocation of the sternoclavicular joint are presented. Their main complaints were chronic recurrent spontaneous dislocation and local tenderness and discomfort during normal use of the shoulder. Two patients were treated according to Brown's modified procedure while four patients were operated with Burrow's technique. Ten weeks immobilization postoperatively is recommended to obtain a satisfactory result.     

腰椎椎弓崩裂合并滑脱的外科治疗初探

分析１９８３年３月至１９９４年５月３３例腰椎椎弓崩裂合并滑脱病人的外科治疗情况，提出病因，诊断要点及手术适应症，强调减压是解除症状的关键，复位前先行松解。就内固定选择进行了比较，认为短棒ｃｏｔｒｅｌ－Ｄｕｂｏｕｓｓｅｒ（ＣＤ）为佳，有效椎弓根内固定是帮助复位，提高融合率的重要措施，高质量的融合可防止再滑脱使远期疗效优良。     

Surgical Treatment of Aneurysms of the Aortic Arch

A new approach to the challenge of surgical treatment of aneurysms of the aortic arch is described. Former techniques have been dependent on separate cannulation of the cerebral arteries, but induction of deep total body hypothermia to 15^°C and circulatory arrest is considered to give sufficient time for resection of the aneurysms and completion of the anastomoses. This is made possible by excising the aneurysms in such a way that the orifices of the three arch vessels are trimmed to leave a small cuff of tissue around the vessels, thereby reducing the number of anastomoses to three. The successful treatment of three patients with this method, is reported.     

Primary hydatid cyst of the scaphoid: case report

Hydatid cyst caused by Echinococcus granulosus is a parasitic disease that can affect different organs. It is difficult to diagnose and has a tendency to recur. Primary bone involvement occurs in 0.5% to 4.0% of all patients with hydatid cysts. We present a 31-year-old woman with a primary hydatid cyst in the left scaphoid. Despite the availability of advanced imaging and laboratory investigation modalities (such as magnetic resonance imaging and serological studies) to make an adequate differential diagnosis of a cystic lesion in our case, intraoperative clinical suspicion led to the diagnosis. This was followed by a successful outcome without recurrence after 12 months.     

A rare combination of hepatic and pericardial hydatid cyst and review of literature

Hydatid disease in human beings, as in all intermediate hosts, manifest as hydatid cyst (HC). It is an important cyclozoonotic disease, endemic in various sheep and cattle raising areas of the world, including India. The tapeworm commonly involved is Echinococcus granulosus. HC can occur almost anywhere in the body, most common organs being liver and lungs, and are usually solitary. In 25% of cases combination of liver HC with HC in other extra pulmonary locations are found. Cardiac HCs comprise of 0.5–2% of all HC cases. Within the heart, HCs are usually situated in the left or right ventricle and rarely found in the peri-cardium. Pericardial HC does not produce symptoms and is often painless and silent, until the cysts grow to a large size over the years, when the usual complications develop, such as cyst rupture, cardiac compression, atrial fibrillation, and even sudden death. We describe the case of a 39 year old house wife, of rural origin, with proximity to livestock, who had an asymptomatic pericardial HC along with a symptomatic hepatic HC. She clinically presented with an abdominal lump for one year with recent onset of abdominal pain for 1 month, when radiological imaging confirmed the diagnosis of an unruptured hepatic HC and a pericardial HC. The patient recovered after pericardiectomy along with excision of the HC over the left ventricle and enucleation of hepatic HC, by thoracoabdominal approach. She is doing well after 5 years of followup without recurrence.     

Intrabiliary Rupture In Liver Hydatid Cysts: Results of 20 Years’ Experience

To assess the diagnostic tools and results of treatment of biliary rupture observed in liver cyst hydatids, clinical findings of 562 patients with hepatic hydatid disease were reviewed.

Imaging techniques were not very effective to determine intrabiliary ruptures. Rates of rupture sizes determined in the patients were as follows; 22 (%24.7) large, 38 (%42.7) small, and 29 (%32.6) occult. Most frequently utilized procedures for patients with intrabiliary rupture were Roux-en-y cystojejunostomy, tube drainage + omentoplasty, sutured fistula + omentoplasty, and sutured fistula + tube drainage. Of the total 25 external biliary fistulas, 21 closed spontaneously. Of the four fistulas that did not close, one was managed by internal drainage and three by endoscopic sphincterotomy.

Preoperative diagnosis of biliary rupture in liver hydatid cyst allows early planning of operation and helps the surgeon design the operative strategy. In the treatment of cases with large rupture, internal drainage may be proposed.